Salpingo Oophorectomy with Appendectomy and Extraction Through Colpotomy

Aaradhya Sharma

https://www.laparoscopyhospital.com/SERV01.HTM  This Video demonstrates right sided Salpingo Oophorectomy with Appendectomy and Extraction Through Colpotomy. Prophylactic removal of the appendix during a benign gynecologic procedure is known as an elective incidental laparoscopic appendectomy. Incidental appendectomy at the time of cesarean delivery was reported initially in 1959. Subsequent studies of removal of a normal-appearing appendix at the time of gynecologic surgery have met with considerable debate. Proponents argue that the removal of the appendix at the time of abdominal hysterectomy does not increase operative time or postoperative morbidity. More important, it does prevent future appendicitis. Advantages of incidental appendectomy include technical ease, low patient morbidity and mortality, and significant diagnostic and protective value. It also prevents conflicting diagnoses, especially in patients who have chronic pelvic pain, a ruptured ovarian cyst, or endometriosis. Other patients likely to benefit from elective incidental appendectomy are those who are undergoing abdominal radiation or chemotherapy, women unable to communicate health complaints, and those who are planning to undergo complex abdominal or pelvic procedures that are likely to cause extensive adhesions.  For more information please contact:  World Laparoscopy Hospital  Cyber City, Gurugram, NCR DELHI  INDIA 122002  Phone & WhatsApp: +919811416838, + 91 9999677788

Transcript

00:00hello friends this is a case of right-sided salpingo-offrectomy with

00:06appendicectomy this patient has a large 18 centimeter ovarian cyst patient age

00:11is 64 so we are not planning to do ovarian cystectomy we will perform

00:16offrectomy and because the patient has recurrent pain previous episodes of

00:21appendicitis so we will do appendicectomy as well and we will remove it by

00:26colpartomy so please come see the case here the ovarian cyst is up to umbilicus so

00:32we will do the access to the palmer's point as you know the palmer's point is

00:36mid clavicular line just below the costal margin so this is the costal margin it is

00:41the left and this is the right subcostal and now this is the mid clavicular line

00:47this is a mid clavicular line but we do here one modification this is palmer's

00:52actually original palmer's is here but we give two centimeter above so that you

00:57don't need to close this port so what we will do that we will first give one a

01:02small stab wound two millimeter stab wound over the inferior criss of umbilicus

01:08sorry over the this two centimeter above the palmer's and after that you will take

01:15the varice drill and point the varice drill and stretch the abdominal wall down and

01:20point to the varice drill right towards the stomach and then you can take

01:25irrigation test suction test and hanging drop test so this is the syringe with

01:32the saline and here is the irrigation test going freely suction test nothing come

01:39out and hanging drop test after that you can attach the tubing of the

01:46insufflator and hanging drop is sucked in this is the tubing of the insufflator we

01:53are using a striker laproflator with the co2 warmer in inbuilt and then you will

01:58start the insufflation so we are keeping here pre-check pressure 15 and actual

02:04pressure is slowly as you can see this is the digital output of our insufflator

02:09actual pressure is slowly increasing and once it will reach to the 15 then we will

02:16stop the insufflator take the varice drill out enlarge the incision to 11 mm and

02:26then the trocar will be introduced and then telescope will be introduced inside so

02:32this way you can enter inside and after that we will start seeing the diagnostic now

02:39this is the baseball index finger is on the right infant lopelvic ligament and thumb is

02:45on the umbilicus and this is the shape of a diamond which you have to make and now it

02:51is more towards the right infant lopelvic so you will draw the arc and table is

02:57coming down percent head is 30 degree down this is first arc at 18 cm and this is

03:03second arc at 24 cm so telescope already we will continue with the palmer's point

03:09but primary port 7.5 cm lateral this will be your left hand and this will be your right

03:15hand so that a good triangulation will be maintained and 60 degree manipulation angle will be achieved

03:21after that this is the second port that is the working port 5 mm which will introduce 7.5 cm

03:30lateral and below the umbilicus this is only 5 mm you don't need 10 mm in this side because we are

03:38planning to remove the ovary as well as appendix through the colpo tummy wound so that you don't

03:43need to enlarge the incision and you don't need big big incision also so this is 5 mm and this is the

03:59trocar assistant gynecologist is introducing here and this is the another port after that you can

04:13puncture the cyst by aspiration needle so here is a aspiration needle and you can initial few ml of

04:21the cystic fluid you can collect into the syringe so that you can send it for FNAC so this is the

04:29trocar inside and this is the another trocar other side and now here is the aspiration needle will

04:39come and it will puncture it is punctured and now in the syringe you will collect the fluid for the

04:48cytological examination here this is the fluid and then suction will suck the all the fluid out and it

04:54is very good simple easy case because all the cystic content is serious it is no any any mucinous or

05:04no any dermoid or no any chocolate it is simple cyst but still the present is postmenopausal so we

05:12will perform the ophrectomy there is no point doing the ovarian cystectomy in those cases so here

05:19antero medial traction will be given and with the harmonic directly you can do salpingo frictomy

05:26keeping yourself as nearer as possible to the ovary and antero medial traction will be given here we

05:33are using harmonic a scalpel but it is up to you you can use like assured you can use bipolar you even

05:41can use monopolar either there is no issue because in front of pelvic ligament is a easy easy process to

05:48allow the desiccation and dissection simultaneously so this is now major salpings and then you will go

05:58to the medial end near the fallopian tube so this is a salpingo frictomy of the right side which is

06:06being carried out now couple of time you can apply little minimum like little coagulation near the

06:25uterus so that there will be no any uteropatorial fistula and then you can coagulate six millimeter

06:31of the tube nearer to the uterus and after that you can cut it so here it is done and now we will

06:51start doing the this sponge pushing in the posterior fornix this is the assistant pushing the sponge in

06:58the posterior fornix and then there will bulge of the sponge and by the harmonic approximately two

07:03to three centimeter below the arc of uterus sacral ligament harmonic is cutting the posterior fornix

07:09that is posterior colpotomy colpotomy wound is very good for tissue retrieval and if you give only two

07:16to three centimeter incision then this sponge will come inside the abdomen over the bulge of the this

07:24sponge there is no possibility of any this bubble or rectum to come out because once you will hold the

07:31cervix with the tenaculum then easily this sponge can be by a screwing movement you will bring the

07:37sponge in now assistant is screwing the sponge and it will come inside the abdomen little bit vaginal

07:46epithelium has to be cut little more and now it is done and now by a screwing movement it is coming

07:52inside uterus sacral ligament will not be touched so that there should not be any effect on the this

08:01support of the uterus so now with this a screwing movement it is coming in and now you can take it

08:10out and here it is going out after that by the side of this a sponge you can put a claw forcep there is a

08:22claw forcep coming that is also called as gall bedded extractor but here as a gynecologist we say

08:29crocodile forcep or claw forcep now the cysts can be held and then slowly entire ovary tube and cysts

08:36can be pulled through the colpotomy wound and here it is going out your assistant here with the claw forcep

08:47we can see this is vaginally coming out and even the huge cysts sometime we have performed a cyst of

08:5430 centimeter also we have performed and that also can be taken out easily we can see here that much

09:02huge cysts all even bigger than that can be taken out by the colpotomy nicely and now you can do thorough

09:09lavage because it is a dependent area so there is no chance of any fluid to retain there now we will

09:15continue appendicectomy here is the momentum and now the appendix will be held up with the same port you

09:22can do appendicectomy also we don't need any extra port and after that you can retract the appendix up

09:29and with the harmonic you can keep on separating the major appendix

09:50slowly major appendix here teflon jaw of the harmonic should be kept towards the shechem

09:55so that any current will not any vibration will not pass over the appendix

10:01and there will be no thermal injury

10:13so now entire major appendix is free it is reached up to the tinea coli up to the cecum

10:27now you can get one visras knot that is extra corporeal knot then you put the grasper in the loop

10:35catch the appendix and negotiate it to go behind the structure now bring to the base of the appendix and you

10:42can tie a knot the tighter knot will be tightened

10:50and it is done

10:54after that you can cut the suture

11:02and then with the harmonic you can sacrifice it leaving six millimeter away from the knot

11:12and it is over appendicular side will seal so there is no issue now again this is a stone holding

11:25forcep you will push the stone holding forcep from the posterior fornix and the base of the appendix will

11:32be held in the spoon forceps so that no spillage and it will be taken out after that you can take a bite

11:39vaginally to close the pop this vault and you can close it so you can see vaginally here it is closer

11:46so thank you very much for watching this video this was just a simple case of

11:52right side salpingo effectomy together with the appendicectomy thank you very much have a nice day

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